Calcifying pseudoneoplasm of the atlantoaxial joint in a child

Calcifying pseudoneoplasm of the spine is a rare nonneoplastic lesion of unknown origin described in adolescents and adults. Its clinical manifestations include axial pain, myelopathy, or radiculopathy. Surgery is the preferred method of treatment. The authors report the occurrence of calcifying pseudoneoplasm at the C1–2 cervical segment in a 22-month-old child who became completely asymptomatic 2 months after open biopsy. A review of the literature is presented, emphasizing the uniqueness of the presented case in comparison with the previously published cases. The 22-month-old healthy girl presented with sudden onset of neck pain. Due to persistence of the symptoms 2 weeks after onset, imaging studies were performed that revealed an inhomogeneous calcified mass extending from the transverse ligament to the C1–2 interlaminar space and facet joint on the left side. Open biopsy of the mass at the C1–2 lamina was performed. The histological features were consistent with calcifying pseudoneoplasm. The child's neck pain progressively improved and she remained asymptomatic at the 1-year follow-up. The postoperative MRI at 8 months did not reveal any progression of the lesion. Contrary to reported cases, calcifying pseudoneoplasm of the spine may occur as early as 2 years of age and should be included in the differential diagnosis of calcified lesions in this age group. Complete resection is not a prerequisite to clinical improvement when there is no compromise of neural structures; conservative management is appropriate.

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Slowly Progressive and Painless Thoracic Aortic Dissection Presenting with a Persistent Fever in an Elderly Patient: The Usefulness of Combined Measurement of Biochemical Parameters

Case Reports in Medicine ◽

10.1155/2013/498129 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Shunsuke Yamada ◽

Masanori Tokumoto ◽

Toshiaki Ohkuma ◽

Yasuo Kansui ◽

Yoshinobu Wakisaka ◽

...

Keyword(s):

Chest Pain ◽

Aortic Dissection ◽

Medical Condition ◽

Correct Diagnosis ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Unknown Origin ◽

Sudden Onset ◽

Proper Diagnosis ◽

Typical Chest Pain

Aortic dissection is a fatal medical condition that requires urgent diagnosis and appropriate intervention. Because acute aortic dissection often manifests as sudden onset excruciating chest pain, physicians can easily reach a proper diagnosis. However, some patients with aortic dissection present with varied clinical manifestations without exhibiting typical chest pain, leading to a delayed diagnosis and possible fatality. We herein present the case of an elderly subject with a fever of unknown origin who was ultimately diagnosed with aortic dissection. In the present case, a negative procalcitonin test, increased D-dimer and serum creatinine phosphokinase-BB levels, and reelevation of the CPR level led us to the correct diagnosis.

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Glossopharyngeal and Hypoglossal Nerve Paralysis Secondary to Prevertebral Phlegmon

Case Reports in Orthopedics ◽

10.1155/2020/3795035 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ryunosuke Fukushi ◽

Izaya Ogon ◽

Yoshinori Terashima ◽

Hiroyuki Takashima ◽

Tsutomu Oshigiri ◽

...

Keyword(s):

Neck Pain ◽

Hypoglossal Nerve ◽

Facet Joint ◽

Retropharyngeal Abscess ◽

Cervical Region ◽

Atlantoaxial Joint ◽

Nerve Paralysis ◽

Pyogenic Spondylitis ◽

Signal Changes ◽

Posterior Pharynx

A 50-year-old man presented to the clinic with severe neck pain, fever, and difficulty breathing and was subsequently admitted to the local orthopedics department with possible retropharyngeal abscess and pyogenic spondylitis. Antibiotic therapy was initiated; however, due to poor oxygenation, he was referred and transferred to our department and admitted. Magnetic resonance imaging showed signal changes at the left C1/2 lateral atlantoaxial joint, posterior pharynx, longus colli muscle, carotid space, and medial deep cervical region, predominantly on the left side. In addition, despite lymph node enlargement from the posterior pharynx to the deep cervical region, there was no abscess formation. There were no signs of a space-occupying lesion or signal changes in the jugular foramen. One day postadmission, the patient’s temperature had risen to 39.1°C and his SpO2 had fallen. His neck pain had also worsened, and emergency surgery was decided. Preoperatively, we suspected retropharyngeal abscess and pyogenic spondylitis. On day 13 postadmission, the patient exhibited dysphagia, deviated tongue protrusion, and the curtain sign. Glossopharyngeal and hypoglossal nerve paralysis were diagnosed. The patient’s swallowing functions recovered and he was discharged on day 36. We experienced a case of glossopharyngeal and hypoglossal nerve paralysis secondary to pyogenic cervical facet joint arthritis.

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Abdominal apoplexy during pregnancy

BMJ Case Reports ◽

10.1136/bcr-2020-235946 ◽

2020 ◽

Vol 13 (10) ◽

pp. e235946

Author(s):

Jasmeet Kumari ◽

Rosemary Harkin

Keyword(s):

Iliac Fossa ◽

Unknown Origin ◽

Breech Presentation ◽

Sudden Onset ◽

Left Iliac Fossa ◽

Safe Delivery ◽

Uterine Contractions ◽

Early Labour ◽

Increased Risk ◽

High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

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Neuralgic amyotrophy: an underrecognized entity

Journal of International Medical Research ◽

10.1177/03000605211006542 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110065

Author(s):

Tae Uk Kim ◽

Min Cheol Chang

Keyword(s):

Clinical Practice ◽

Magnetic Resonance ◽

Clinical Manifestations ◽

Clinical History ◽

Cervical Radiculopathy ◽

Sudden Onset ◽

Clinical Findings ◽

Magnetic Resonance Neurography ◽

Essential Information ◽

Neuralgic Amyotrophy

Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient’s clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.

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SAT0547 RADIOGRAPHIC IMAGING IN ASSESSMENT OF FLUOROSCOPIC GUIDED INJECTION OF RHEUMATOID ATLANTOAXIAL JOINT INFLAMMATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1810 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1230.1-1231

Author(s):

D. Fouad ◽

S. Rashad ◽

M. Ghaly ◽

M. Hassanien

Keyword(s):

Rheumatoid Arthritis ◽

Neck Pain ◽

Sleep Quality ◽

Sleep Disturbance ◽

Steroid Injection ◽

Therapeutic Option ◽

Control Group ◽

Atlantoaxial Joint ◽

Post Intervention

Background:Rheumatoid spondylitis is a feature of long-lasting Rheumatoid arthritis (RA) that is presented by neck pain, headache and sleep disturbance. Atlantoaxial joint (AAJ) is the commonest cervical spine joint that affected in patients with RA. When it is involved, it can be associated with dangerous complications. Magnetic Resonance Imaging (MRI) can be used for assessing the disease activity, the amount of cartilage destruction, associated cervical myelopathy and differentiating synovial fluid from inflammatory pannus (Taniguchi D, et al., 2008).Objectives:This study aimed to evaluate the efficacy of intra-articular steroid injection of inflamed AAJ in RA patients, regarding neck pain, headache and sleep quality using pre and post-interventions MRI.Methods:A prospective case control study. Patients with inflamed AAJ were recruited. Group 1 (AAJ group, n = 30), received intraarticular AAJ steroid injection, guided by fluoroscopy and Group 2 (control group, n = 30), received systemic steroids. Both groups were assessed with: Visual Analogue scale (VAS) for nocturnal neck pain and headache. Pittsburgh sleep quality index (PSQI) was used for sleep disturbance. Pre and post contrasts enhanced MRI interventions were done for both groups during the period of follow up (three months).Results:Nocturnal neck pain, headache and sleep disturbance have significantly decreased, during follow up visits (3 months), in AAJ group in comparison to the control group. The Pre-intervention nocturnal pain score was 60.3 ±17.1 in AAJ group & 58.5 ±17.9 in control group. Pain has significantly decreased after 2weeks in AAJ group with continuous improvement till 3 months’ post-intervention 6.9 ±4.65 & 51.26 ±10.54 respectively. The pre-intervention headache was 22.68 ±16.74 in AAJ group & 45.17 ±15.83 in control group decreased to 7.54 ±5.23 & 48.52 ±11.98 respectively post intervention. The percentage of patients who had sleep disturbance at baseline was 66.7% & 73.3% in AAJ and control groups respectively which has significantly decreased to 6.7% & 43.3% after 3 months. Regarding MRI, AAJ group hada statistical significant decreasein the percentage of patients with MRI synovial enhancement, inflammatorypannus,fibrosis and bone marrow edema in comparison to control group 3 months post intervention. All post-procedural side effects resolved within thmonth without further medical intervention, and no long-term sequelae were identifiedConclusion:Fluoroscopic guided intra-articular steroid injection of inflamed atlantoaxial joints is considered a beneficial therapeutic option in rheumatoid arthritis patients regarding clinical and radiological assessments.References:[1]Taniguchi D, Tokunaga D, Hase H, et al. Evaluation of lateral instability of AAJ in RA using dynamic open-mouth view radiographs. Clin Rheumatol.2008 Jul. 27(7):851-7.Disclosure of Interests:None declared

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Neurofibromatosis type 1 with subarachnoid haemorrhage from the left vertebral arteriovenous fistula: case presentation and literature review

BMJ Case Reports ◽

10.1136/bcr-2020-239880 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239880

Author(s):

Toshinori Nishizawa ◽

Takahiro Tsuchiya ◽

Yoshihiro Terasawa ◽

Yasuhiro Osugi

Keyword(s):

Neck Pain ◽

Subarachnoid Haemorrhage ◽

Arteriovenous Fistula ◽

Neurofibromatosis Type 1 ◽

Epidural Haematoma ◽

Neurofibromatosis Type ◽

Sudden Onset ◽

Vertebral Arteriovenous Fistula ◽

First Case

We present the case of a 47-year-old woman with neurofibromatosis type 1 (NF1) with subarachnoid haemorrhage (SAH) from the left vertebral arteriovenous fistula, along with a review of previous cases. Our patient had a family history of NF1 and presented to the emergency department with a sudden-onset severe headache and neck pain. CT scan showed SAH. CT angiography revealed a left vertebral arteriovenous fistula and an epidural haematoma. She underwent direct surgery and was discharged without neurologic deficits. To our knowledge, this is the first case of SAH caused by perimedullary drainage of a vertebral arteriovenous fistula associated with NF1. In a literature search, we identified 40 cases of vertebral arteriovenous fistula associated with NF1. The majority of vertebral arteriovenous fistulas occurred on the left side and in women. Patients with vertebral arteriovenous fistula typically experience neck pain, radiculopathy, radiculomyelopathy and bruits.

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Abstract 212: Acute Myocardial Infarction in the Acute Phase in Kawasaki Disease in Mexican Children.

Circulation ◽

10.1161/circ.131.suppl_2.212 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

William Sarmiento-Robles ◽

Luis M Garrido-Garcia

Keyword(s):

Myocardial Infarction ◽

Kawasaki Disease ◽

Acute Phase ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Unknown Origin ◽

Z Score ◽

Laboratory Parameters ◽

Small Series ◽

Coronary Aneurysms

Background: Kawasaki disease (KD) is an acute febrile vasculitis of unknown origin. Despite treatment with intravenous immunoglobulin during the acute phase of the disease, up to 5% of those affected will develop coronary aneurysms predisposing them to thrombotic complications that could result in myocardial infarction (AMI). In Mexico there are few reports of ischemic complications secondary to KD. Objective: To describe the clinical features, the laboratory parameters, treatment used and the outcome of children who presented with myocardial infarction during the acute phase of KD in a third level facility in Mexico City Methods: From our Institutional Database of KD we search for children who presented AMI in the acute phase of the disease from August 1995 to August 2014. We analyzed gender, age, clinical manifestations, time from the onset of the symptoms to diagnosis, laboratory parameters, treatment used, and outcome in the acute phase of the disease. Results: Eight infants were diagnosed with AMI during the study period. The median age at diagnosis was 8 months (range 2 to 53 months). Seven patients were male (87.5%). The median from the onset of the clinical manifestations to diagnosis of KD was 22 days (range 4 to 26 days). All patients developed giant coronary aneurysms (median Z-score 18.98, with a range of Z-score from 11.58 - 27.70). An abnormal EKG and abnormal perfusion tests demonstrated the myocardial infarction in all cases. Two patients died in the acute phase of cardiogenic shock, one more patient died of dilated cardiomyopathy 12 months after coronary bypass surgery with an overall mortality of 62.5% of this group. Conclusions: AMI is a fatal complication of KD. In our small series it was associated with a delayed diagnosis of the disease and therefore the development of giant coronary aneurysms. Treatment of AMI in children after KD is a medical challenge with a poor prognosis in children.

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The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

BioMed Research International ◽

10.1155/2016/8069354 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Kuang-Ting Yeh ◽

Ru-Ping Lee ◽

Ing-Ho Chen ◽

Tzai-Chiu Yu ◽

Cheng-Huan Peng ◽

...

Keyword(s):

Neck Pain ◽

Facet Joint ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Standard Technique ◽

Invasive Technique ◽

Open Door ◽

Gradual Improvement ◽

Less Invasive

Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1–4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes.

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Posterior Ligamentous Complex Reconstruction for Cervical Dislocation and Instability in Patients without Vertebral Fracture with Artificial Ligaments: A Technical Note

10.21203/rs.3.rs-103566/v1 ◽

2020 ◽

Author(s):

Chengyi Huang ◽

Beiyu Wang ◽

Hao Liu ◽

Tingkui Wu ◽

Kangkang Huang ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Fracture ◽

Neck Pain ◽

Facet Joint ◽

Spinous Process ◽

Posterior Ligamentous Complex ◽

Reconstruction Surgery ◽

Artificial Ligaments ◽

Cervical Surgery ◽

Patient Reported

Abstract Introduction: The posterior ligamentous complex (PLC) offers restraints to deformation in a complex and interconnected manner. The stability and range of motion (ROM) of the posterior cervical spine is greatly restricted when the PLC is damaged, even without bone disruptions. We describe a novel surgical technique, its advantages, and the postoperative condition of the first patient to use artificial ligament in a reconstruction surgery of PLC injuries in patients without lower cervical vertebral fracture. This technique aimed to fully retain the mobility of the injured segment based on spinal stability and apply dynamic reconstruction in patients’ treatment.Method: We present a detailed description of the reconstruction surgery with artificial ligaments performed on C4-6 PLC injuries in a 27-year-old male presented with neck pain and restricted movement following a high fall injury accompanied by impaired movement of limbs. Results: Immediately postsurgery, the patient’s neck pain and quadriparesis had been improved. The spinal canal decompression and cervical spine sequence results were satisfactory, the facet joint face was in a good position, and the spinous process spacing returned to normal. After three months of rehabilitation, the patient reported improvement of symptoms and the physical and imaging examination showed a significant improvement in the patient’s condition. The patient’s neck mobility motor function had improved further.Conclusion: The present data demonstrate that the novel technique for reconstruction of PLC injury is feasible and safe. However, familiarity with cervical anatomy and adequate experience in lateral mass screws placement during surgery is crucial for this procedure. Therefore, a highly experienced cervical surgery team is recommended to perform the surgery.

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Porencephalic Cyst in an Adult - A Rare Pathology

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/198 ◽

2021 ◽

Vol 10 (12) ◽

pp. 918-919

Author(s):

Shreya Tapadia ◽

Suresh Vasant Phatak ◽

Harshith Gowda K.B ◽

Asish Pavanan

Keyword(s):

Cerebrospinal Fluid ◽

White Matter ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Sudden Onset ◽

Brain Parenchyma ◽

Motor Deficits ◽

Cystic Degeneration ◽

Lateral Side ◽

Porencephalic Cyst

Porencephalic cyst is a rare entity in adults with limited cases reported so far. It is usually congenital and seen in neonates. Here, we report a 25-year-old male who presented with post-ictal confusion following an episode of sudden onset of generalised tonic clonic seizure. He was diagnosed to have large cerebrospinal fluid (CSF) density cystic lesion in the right parieto-occipital region communicating with occipital horn on right side side of porencephaly. Porencephaly is an uncommon congenital disorder that occurs due to cystic degeneration and encephalomalacia leading to porencephalic cyst formation.1 They are considered to occur most commonly from focal encephalomalacia due to a localised cerebral insult during early gestation, 2 while the other aetiologies include trauma, infection, antenatal intraparenchymal haemorrhage and perinatal cerebral ischemia.3 If the insult occurs in late third trimester it can lead to gliosis. Porencephalic cysts are typically lined by white matter of brain parenchyma.2 They differ widely in their location and size while the clinical manifestations and presentations range from being asymptomatic to extremely impaired mental function. Generally, the signs and symptoms of porencephaly become apparent in the first year of life. The earliest manifestation being spasticity and seizures. As the age increases there is a delay in development of milestones presenting as language impairment, disability in intellect and motor deficits. Clinically head circumference measurement varies from being normal or small to an enlarged head in cases of synechiae formation that creates a one-way valve effect leading to progressive enlargement of the cyst and expansion of skull or there may be hydrocephalus.4 Radiologically the diagnosis depends on demonstrating a well-defined CSF-filled space occupying lesion lined by white matter and communicating with ventricles on computed tomography (CT) scan or magnetic resonance imaging (MRI) of brain. The prognosis of porencephaly depends on the location and extent of the cyst.5 If the cyst is very large it can cause mass effect in the form of scalloping of adjacent bone, buckling of brain parenchyma, midline shift to contra lateral side and hydrocephalus. On MRI, brain cyst appears well defined and lined by white matter with or without gliosis. Cerebrospinal fluid is the content which is shown as hypointense on T1 and hyperintense on T2.

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